Pathoma Chapter 8 Exam Study Guide
Latest Updated Guide 2024/2025
Ischemic Heart Disease Definition - ansGroup of syndromes
related to myocardial ischemia
Ischemia - ansDecreased blood flow to an organ
What is the leading cause of death in US? - ansIschemic heart
disease
What usually causes IHD? - ansAtherosclerosis of coronary
arteries, decreasing blood flow to myocardium
What are risk factors for IHD? - ansSimilar to those for
atherosclerosis; incidence increases with age
Stable angina definition - anschest pain that arises with exertion
or emotional stress
What causes stable angina? - ansAtherosclerosis of coronary
arteries with over 70% stenosis, so decreased blood flow can't
meet metabolic demands of the myocardium on exertion
Does stable angina represent reversible or irreversible injury to
myocytes? - ansReversible
What is the hallmark of reversible cell injury? - ansCellular
swelling
How does stable angina present? - ansChest pain lasting less
than 20 minutes that ratiates to left arm/jaw, perhaps with
diaphoresis and shortness of breath
What does an EKG in stable angina show? - ansST segment
depression due to subendocardial ischemia
What area of the heart is most susceptible to damage with
coronary atherosclerosis? - ansSubendocardium
Name the three layers of the heart; in which layer do the
coronary arteries begin? - ansEpicardium; myocardium;
endocardium; coronary arteries begin in the epicardium
,Pathoma Chapter 8 Exam Study Guide
Latest Updated Guide 2024/2025
How do you relieve stable angina - ansRest or nitroglycerin
What is nitroglycerin's mechanism of action? - ansVasodilation
of arteries and veins
Unstable angina definition - ansChest pain that occurs at rest
Is unstable angina reversible or irreversible injury to myocytes?
- ansReversible (no necrosis)
What usually causes unstable angina - ansRupture of
atherosclerotic plaque with thrombosis and incomplete occlusion
of a coronary artery
EKG in unstable angina - ansST-segment depression due to
subendocardial ischemia
How do you relieve unstable angina - ansNitroglycerin
What is the risk of unstable angina - ansProgression to MI
Prinzmetal angina definition - ansEpisodic chest pain unrelated
to exertion but caused by coronary artery vasospasm (artery
clamps down and cuts blood supply)
Is prinzmetal angina reversible or irreversible injury in
myocytes? - ansReversible
What does EKG show in unstable angina and why? - ansST-
segment elevations due to transmural ischemia
What relieves unstable angina - ansNitroglycerin or Ca channel
blockers (to relieve vasospasm)
Myocardial infarction definition - ansNecrosis of cardiac
myocytes
What usually causes MI? Name three lesser causes - ansRupture
of atherosclerotic plaque with thrombosis and complete
occlusion of a coronary artery
Other causes: prinzmetal angina, vasculitis, emboli
, Pathoma Chapter 8 Exam Study Guide
Latest Updated Guide 2024/2025
Is it complete or incomplete occlusion of a coronary artery in
MI? - ansComplete
Clinical features of MI - ansCrushing chest pain for more than
20 minutes that radiates to left arm or jaw, diaphoresis, dyspnea,
symptoms not relieved by nitroglycerin
Does nitroglycerin relieve MI symptoms? - ansNo
What ventricle is usually involved in MI and what ventricles are
usually spared? - ansLV involved usually
RV and both atria are generally spared
What are the three most commonly involved coronary arteries in
MI and what areas of the heart do they affect? - ansLAD: affects
anterior LV wall and anterior septum
Right Circumflex: affects posterior LV wall and posterio septum
and LV papillary muscles
Left Circumflex: affects lateral wall of LV
What part of the myocardial wall does the initial phase of
infarction involve? - ansSubendocardial necrosis involving less
than 50% of the myocardial thickness (ST depressions)
What does continued or severe ischemia in MI cause on EKG,
and why? - ansST segment elevations due to transmural
infarction
What are the two laboratory tests to detect MI? - ansTroponin I
(peaks 2-4 hours after infarction and returns to normal 7-10 days
later)
CK-MB (reinfarction, returns to normal by 72 hours)
What enzyme do you check in reinfarction in under 7-10 days? -
ansCK-MB
Name six treatments for MI - ans1. Aspirin/heparin
Latest Updated Guide 2024/2025
Ischemic Heart Disease Definition - ansGroup of syndromes
related to myocardial ischemia
Ischemia - ansDecreased blood flow to an organ
What is the leading cause of death in US? - ansIschemic heart
disease
What usually causes IHD? - ansAtherosclerosis of coronary
arteries, decreasing blood flow to myocardium
What are risk factors for IHD? - ansSimilar to those for
atherosclerosis; incidence increases with age
Stable angina definition - anschest pain that arises with exertion
or emotional stress
What causes stable angina? - ansAtherosclerosis of coronary
arteries with over 70% stenosis, so decreased blood flow can't
meet metabolic demands of the myocardium on exertion
Does stable angina represent reversible or irreversible injury to
myocytes? - ansReversible
What is the hallmark of reversible cell injury? - ansCellular
swelling
How does stable angina present? - ansChest pain lasting less
than 20 minutes that ratiates to left arm/jaw, perhaps with
diaphoresis and shortness of breath
What does an EKG in stable angina show? - ansST segment
depression due to subendocardial ischemia
What area of the heart is most susceptible to damage with
coronary atherosclerosis? - ansSubendocardium
Name the three layers of the heart; in which layer do the
coronary arteries begin? - ansEpicardium; myocardium;
endocardium; coronary arteries begin in the epicardium
,Pathoma Chapter 8 Exam Study Guide
Latest Updated Guide 2024/2025
How do you relieve stable angina - ansRest or nitroglycerin
What is nitroglycerin's mechanism of action? - ansVasodilation
of arteries and veins
Unstable angina definition - ansChest pain that occurs at rest
Is unstable angina reversible or irreversible injury to myocytes?
- ansReversible (no necrosis)
What usually causes unstable angina - ansRupture of
atherosclerotic plaque with thrombosis and incomplete occlusion
of a coronary artery
EKG in unstable angina - ansST-segment depression due to
subendocardial ischemia
How do you relieve unstable angina - ansNitroglycerin
What is the risk of unstable angina - ansProgression to MI
Prinzmetal angina definition - ansEpisodic chest pain unrelated
to exertion but caused by coronary artery vasospasm (artery
clamps down and cuts blood supply)
Is prinzmetal angina reversible or irreversible injury in
myocytes? - ansReversible
What does EKG show in unstable angina and why? - ansST-
segment elevations due to transmural ischemia
What relieves unstable angina - ansNitroglycerin or Ca channel
blockers (to relieve vasospasm)
Myocardial infarction definition - ansNecrosis of cardiac
myocytes
What usually causes MI? Name three lesser causes - ansRupture
of atherosclerotic plaque with thrombosis and complete
occlusion of a coronary artery
Other causes: prinzmetal angina, vasculitis, emboli
, Pathoma Chapter 8 Exam Study Guide
Latest Updated Guide 2024/2025
Is it complete or incomplete occlusion of a coronary artery in
MI? - ansComplete
Clinical features of MI - ansCrushing chest pain for more than
20 minutes that radiates to left arm or jaw, diaphoresis, dyspnea,
symptoms not relieved by nitroglycerin
Does nitroglycerin relieve MI symptoms? - ansNo
What ventricle is usually involved in MI and what ventricles are
usually spared? - ansLV involved usually
RV and both atria are generally spared
What are the three most commonly involved coronary arteries in
MI and what areas of the heart do they affect? - ansLAD: affects
anterior LV wall and anterior septum
Right Circumflex: affects posterior LV wall and posterio septum
and LV papillary muscles
Left Circumflex: affects lateral wall of LV
What part of the myocardial wall does the initial phase of
infarction involve? - ansSubendocardial necrosis involving less
than 50% of the myocardial thickness (ST depressions)
What does continued or severe ischemia in MI cause on EKG,
and why? - ansST segment elevations due to transmural
infarction
What are the two laboratory tests to detect MI? - ansTroponin I
(peaks 2-4 hours after infarction and returns to normal 7-10 days
later)
CK-MB (reinfarction, returns to normal by 72 hours)
What enzyme do you check in reinfarction in under 7-10 days? -
ansCK-MB
Name six treatments for MI - ans1. Aspirin/heparin
